From the Departments of Allergology and Clinical Immunology.
Anaesthesia.
Anesth Analg. 2018 Aug;127(2):414-419. doi: 10.1213/ANE.0000000000002656.
Differentiating between immunoglobulin E (IgE)-dependent and IgE-independent hypersensitivity reactions may improve the etiologic orientation and clinical management of patients with allergic reactions in the anesthesia setting. Serum tryptase levels may be useful to discriminate the immune mechanism of allergic reactions, but the diagnostic accuracy and optimal cutpoint remain unclear.We aimed to compare the diagnostic accuracy of tryptase during reaction (TDR) alone and the TDR/basal tryptase (TDR/BT) ratio for discriminating IgE- from non-IgE-mediated allergic reactions, and to estimate the best cut point for these indicators.
We included 111 patients (45% men; aged 3-99 years) who had experienced an allergic reaction, even though the allergic reaction could be nonanaphylactic. Allergy tests were performed to classify the reaction as an IgE- or non-IgE-mediated one. The area under the curve (AUC) of the receiver operating characteristic analysis was performed to estimate the discriminative ability of TDR and TDR/BT ratio.
An IgE-mediated reaction was diagnosed in 49.5% of patients, and 56% of patients met anaphylaxis criteria. The median (quartiles) TDR for the IgE-mediated reactions was 8.0 (4.9-19.6) and 5.1 (3.5-8.1) for the non-IgE-mediated (P = .022). The median (quartiles) TDR/BT ratio was 2.7 (1.7-4.5) in IgE-mediated and 1.1 (1.0-1.6) in non-IgE-mediated reactions (P < .001). The TDR/BT ratio showed the greatest ability to discriminate IgE- from non-IgE-mediated reactions compared to TDR (AUC TDR/BT = 0.79 [95% confidence interval (CI), 0.70-0.88] and AUC TDR = 0.66 [95% CI, 0.56-0.76]; P = .001). The optimal cut point for TDR/BT (maximization of the sum of the sensitivity and specificity) was 1.66 (95% CI, 1.1-2.2).
The TDR/BT ratio showed a significantly better discriminative ability than TDR to discriminate IgE- from non-IgE-mediated allergic reactions. An optimal TDR/BT ratio threshold of approximately 1.66 may be useful in clinical practice to classify allergic reactions as IgE- or non-IgE-mediated.
区分免疫球蛋白 E（IgE）依赖性和 IgE 非依赖性超敏反应可能有助于改善麻醉环境中过敏反应患者的病因定位和临床管理。血清类胰蛋白酶水平可能有助于区分过敏反应的免疫机制，但诊断准确性和最佳切点仍不清楚。本研究旨在比较反应时类胰蛋白酶（TDR）和 TDR/基础类胰蛋白酶（TDR/BT）比值单独用于鉴别 IgE 介导和非 IgE 介导的过敏反应的诊断准确性，并估计这些指标的最佳切点。
我们纳入了 111 名（45%为男性；年龄 3-99 岁）发生过敏反应的患者，尽管过敏反应可能是非过敏性的。进行过敏测试以将反应分类为 IgE 介导或非 IgE 介导。使用受试者工作特征分析的曲线下面积（AUC）评估 TDR 和 TDR/BT 比值的鉴别能力。
49.5%的患者被诊断为 IgE 介导的反应，56%的患者符合过敏反应标准。IgE 介导反应的中位数（四分位数）TDR 为 8.0（4.9-19.6），而非 IgE 介导反应的中位数（四分位数）TDR 为 5.1（3.5-8.1）（P=0.022）。TDR/BT 比值在 IgE 介导反应中为 2.7（1.7-4.5），在非 IgE 介导反应中为 1.1（1.0-1.6）（P<0.001）。与 TDR 相比，TDR/BT 比值具有更好的鉴别 IgE 与非 IgE 介导反应的能力（TDR/BT 的 AUC=0.79[95%置信区间（CI），0.70-0.88]和 TDR 的 AUC=0.66[95%CI，0.56-0.76]；P=0.001）。TDR/BT 的最佳切点（敏感性和特异性之和最大化）为 1.66（95%CI，1.1-2.2）。
TDR/BT 比值比 TDR 具有更好的鉴别能力，可用于鉴别 IgE 与非 IgE 介导的过敏反应。约 1.66 的 TDR/BT 比值切点可能有助于临床实践中将过敏反应分类为 IgE 或非 IgE 介导。
